Nutritional and Fasting Strategies for the Management of MASLD/MASH: An Integrative Review

Non-alcoholic fatty liver disease (NAFLD), recently redefined as metabolic dysfunction-associated steatotic liver disease (MASLD), has emerged as the most common chronic liver disease worldwide, affecting nearly one in three adults. Despite its growing prevalence, there is still no approved pharmacological treatment, making lifestyle modification the cornerstone of management. Among the most promising strategies are nutritional interventions and structured fasting regimens, which target the underlying metabolic dysfunction driving disease progression. This review explores the impact of various dietary patterns-including the Mediterranean diet, low-glycemic index and low-carbohydrate diets, plant-based approaches, and the DASH diet-on hepatic steatosis, liver enzymes, and metabolic health. Evidence from randomized trials and meta-analyses highlights the Mediterranean diet as particularly effective in reducing liver fat and improving cardiometabolic outcomes, especially when combined with physical activity. Plant-based and DASH diets also demonstrate significant benefits, although accessibility, adherence, and cultural factors remain as challenges. Fasting interventions, such as intermittent fasting, time-restricted eating, alternate-day fasting, periodic fasting, and the fasting-mimicking diet, have gained increasing attention. These regimens improve insulin sensitivity, promote fat oxidation, and reduce intrahepatic fat, with growing evidence supporting their safety and effectiveness in MASLD management. While results are encouraging, long-term adherence, standardization of fasting protocols, and individualized patient considerations remain key areas for future research. In summary, nutritional and fasting strategies represent practical, non-pharmacological options to prevent and manage MASLD. By addressing both hepatic and systemic metabolic dysfunction, they hold promise not only for improving liver health but also for reducing the broader burden of obesity, diabetes, and cardiovascular disease.